Just Get on the Pill: The Uneven Burden of Reproductive Politics By Krystale E. Littlejohn. Oakland: University of California Press, 2021, 184 pp.
Just Get on the Pill : The Uneven Burden of Reproductive Politics. Krystale E. Littlejohn, Oakland, California: University of California Press, 2021, 184 pp.
University of Texas, Austin
Just Get on the Pill by Krystale E. Littlejohn discusses the phenomenon of “gendered compulsory birth control,” which she describes as the process for socializing women into accepting primary responsibility for preventing pregnancy through using “female” birth control. Throughout the book, Littlejohn questions the ways that people have been socialized to accept this division of labor as natural, and makes a strong case for the injustice of this unequal burden of contraceptive use. With increased concerns about future legal limitations on contraceptive access in the United States, this book is timely in its call to envision a more just, equitable system that promotes free access of all contraception for everyone.
Data come from a larger qualitative research project where 103 unmarried women were asked about their experiences with contracepting when they did not desire a pregnancy; approximately half had experienced pregnancy and all had used a form of contraception before. Littlejohn utilizes autoethnography throughout to detail how her own reproductive experiences intersect with t research participants’ experiences. She describes this as reflective of a Black feminist epistemology, where situating her own experiences in connection to those of her research participants also shapes her approach to analyzing and learning from the data (p.47, 143). This approach also engages the reader to think about how their own experiences and behaviors might also be shaped by gendered, social expectations for contraceptive use. The methodological section is short, and I would have liked more detail about who conducted the interviews and about the larger research study. Additionally, the primary demographic categories used in the text to describe participants are race and age, and at times I wanted additional detail, such as more information about people’s past or current relationships, as well as information about the sexuality of participants; interviews are all be from women who had experienced sex with men, but information about sexuality is not included in the demographics. However, the author does a good job in showing the range of experiences of study participants overall and integrating these experiences into the theoretical argument.
Hormonal contraception is often described as a means for self-efficacy and liberation for women, by providing autonomy over pregnancy decision-making and outcomes, however scholars using a reproductive justice framework have challenged this assumption (Drucker 2020). Littlejohn’s argument on gendered compulsory birth control argues that the presumed benefits can become harms as women are socialized into accepting primary responsibility for using hormonal birth control and bearing the burden of preventing pregnancy. This expectation that women are primarily responsible for contraception can become a form of violence, or reproductive oppression, as women are told by their families, friends, partners, and physicians that they should “just get on the pill.” This system of gendered compulsory birth control creates a reality of “agency without choice” (p.59), where women’s contraceptive choices are constrained by the expectations that they use hormonal birth control, as it is considered “highly effective,” and they face blame for failing to control their reproductive bodies if they choose not to do so.
In the first two chapters, Littlejohn describes the role of language in creating this gendered system. She argues that the gendering of condoms as “male” versus “female,” imbues neutral technologies with pre-existing gendered narratives about bodies and social expectations for how they will be used; men use “male” or external condoms and women use “female” contraception such as the hormonal birth control pill, long-acting reversable contraception (LARC), and internal or “female” condoms. This gendering of condoms also represents heteronormative and cisgendered assumptions about sexual encounters and the ways that people are using condoms. It also creates social limitations for women who might prefer to use barrier methods like “male condoms” as a primary form of birth control to avoid side effects of hormonal birth control and/or to prevent sexually transmitted infections. The participants in this study described feeling uncomfortable acquiring condoms and initiating condom use because of these gendered norms that men are responsible for purchasing and wearing condoms, resulting in a diminishing of women’s agency in condom use.
The final chapters deal with women’s processes of resistance to this expectation they assume the primary responsibility for preventing pregnancy through contraceptive use. Littlejohn argues that dominant public health narratives frame condoms as less effective than hormonal contraception or LARC, funneling women towards hormonal birth control. Rather than presenting women who refuse contraception through stereotypes like being irresponsible or noncompliant, or assuming a lack of desire to prevent pregnancy, Littlejohn shows that refusal can be a way of reclaiming reproductive autonomy and a recognition of the inequality of the current burden of contraceptive responsibility. This argument connects to other work challenging the use of “unintended pregnancy” as a problematic measure of reproductive autonomy, which the authors argue assumes women are using methods that they have freely chosen and valorizes the use of highly effective contraceptive methods (Potter et al. 2019). Littlejohn argues that contraceptive effectiveness is a socially situated measure, rather than a neutral one, as highly effective contraceptives are only effective because women have committed to using them consistently. Focusing on the use of “highly effective contraception” also leaves out the behaviors of women’s sexual partners, which are just as important to contraceptive decision-making and use in practice (p.6). As narratives throughout the book show, the gendering of methods combined with the expectation that women use more “effective,” hormonal birth control was described by participants as a reason that their male partners thought they should not have to wear condoms; and this unequal gendered labor for preventing “unintended pregnancy” was sometimes negotiated through a preference to use condoms over hormonal birth control in relationships.
Just Get on the Pill introduces readers to concepts such as socialization and gender roles, along with reproductive autonomy, reproductive justice, and gender inequality. Littlejohn’s writing intentionally describes theoretical concepts in conjunction with participants’ embodied and experiential knowledge, which is an effective means of uplifting the value of embodied knowledge and makes the explanations of theory both clear and accessible to a broad audience. This book is appropriate for undergraduate courses in medical anthropology, linguistics, and gender studies, as it will provide ample opportunities for students to interrogate how gender ideology and socialization shapes their own assumptions about and experiences with contraceptive use. Additionally, this book would be of interest to graduate students in public health and medical students, for discussions about how these fields have contributed to this system of gendered compulsory birth control, and what future practitioners can do to promote a more justice-oriented approach to contraceptive access.
Drucker, Donna J. 2020. Contraception : A Concise History. The MIT Press Essential Knowledge Series. Cambridge: The MIT Press.
Potter, Joseph E., Amanda Jean Stevenson, Kate Coleman-Minahan, Kristine Hopkins, Kari White, Sarah E. Baum, and Daniel Grossman. 2019. “Challenging Unintended Pregnancy as an Indicator of Reproductive Autonomy.” Contraception 100 (1): 1–4. https://doi.org/10.1016/j.contraception.2019.02.005.